From the Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, and the Department of Public Health, Erasmus MC, the Institute of Health Policy and Management, and Rotterdam Midwifery Academic (Verloskunde Academie Rotterdam), Rotterdam, The Netherlands.
Obstet Gynecol. 2011 Nov;118(5):1037-1046. doi: 10.1097/AOG.0b013e3182319737.
The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment.
The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth.
Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase).
Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.
本研究的目的是在调整病例组合后，比较社区助产士主导的计划家中分娩与计划医院分娩的产时和新生儿早期死亡率。
从荷兰围产期登记处（2000-2007 年）获得了 679952 名低危妇女的围产期结局。这组人群代表了所有在家庭分娩和医院分娩之间有选择的妇女。进行了两种不同的分析：自然前瞻性方法（意向治疗样分析）和完美指南方法（方案分析）。计算了未经调整和调整的优势比（OR）。病例组合基于以下至少一种情况的存在：先天性异常、小于胎龄儿、早产或低 Apgar 评分。我们还研究了预期分娩地点的潜在风险作用。多变量逐步逻辑回归用于调查预期分娩地点的潜在风险作用。
计划在家中分娩的产时和新生儿在 0-7 天内死亡的比例为 0.15%，而计划在医院分娩的比例为 0.18%（粗相对风险 0.80，95%置信区间 [CI] 0.71-0.91）。在调整病例组合后，这种关系发生逆转，表明在家分娩的死亡率风险增加无统计学意义（OR 1.05，95%CI 0.91-1.21）。在某些亚组中，如果在分娩时出现风险情况，在家中可能会出现额外的死亡（增加高达 20%）。
在常规条件下，家庭分娩通常不会增加产时和新生儿早期死亡的风险，但在某些亚组中，不能排除额外的风险。
